PM&R最新文献

{"title":"\"I'd rather be in pain than be patronized.\" A qualitative study of health care experiences of persons with disabilities.","authors":"Jessica A Prokup, Elise M Pearson, Alan Cuevas Villagomez, Kristyn L Felman, Amy J Houtrow, Max B Hurwitz","doi":"10.1002/pmrj.13424","DOIUrl":"https://doi.org/10.1002/pmrj.13424","url":null,"abstract":"<p><strong>Background: </strong>Prior research shows that persons with disabilities (PWD) frequently receive inadequate health care and that physicians are uncomfortable caring for patients with disabilities, both of which may be attributed to the lack of disability education in medical training. Little is known about what adequate training would include or what PWD wish physicians knew about their experiences.</p><p><strong>Objective: </strong>To inform the design of a preclinical elective course for medical students by learning from PWD what they believe is most important for physicians to know when providing their care.</p><p><strong>Design: </strong>Semistructured interviews.</p><p><strong>Setting: </strong>PWD in the greater Pittsburgh region.</p><p><strong>Participants: </strong>We recruited individuals aged 18 years and older with disabilities, as well as parents of children with disabilities. Purposive, expert sampling and snowball recruitment took place through medical clinics familiar to the study, social media, and naturally occurring social networks. Of the 94 individuals who expressed interest, 15 were selected to participate.</p><p><strong>Methods: </strong>Fifteen one-to-one interviews were conducted using a semistructured interview guide, and key themes were identified using thematic analysis.</p><p><strong>Results: </strong>Study participants described many things they wanted physicians to understand prior to providing their care. They explained the preparation and collaboration necessary to adequately accommodate disability-related needs and the significant impact that failing to do so has on their health and well-being. They also offered examples of good care and practical suggestions for improving care.</p><p><strong>Conclusion: </strong>Participants highlighted critical gaps in the health care system, underscoring the need for medical education that includes providing care to PWD and a better understanding of disability-related needs. Although the purpose of the study was to inform a preclinical elective course for medical students, this alone is insufficient to train a competent workforce. Further curriculum work is needed to ensure students receive a broad education on disabilities, including both clinical and preclinical instruction.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Core program elements for equitable, effective participation in a lifestyle medicine program for chronic musculoskeletal pain.","authors":"Elsa M Snider, Christine Y Gou, Ling Chen, Adriana Martin, K Ellie Ito, Devyani M Hunt, Abby L Cheng","doi":"10.1002/pmrj.13416","DOIUrl":"https://doi.org/10.1002/pmrj.13416","url":null,"abstract":"<p><strong>Background: </strong>Despite growing interest in using lifestyle medicine to address chronic musculoskeletal pain, challenges remain in equitably and effectively delivering lifestyle-related interventions to this population.</p><p><strong>Objective: </strong>To identify program elements that affect engagement with, and effective delivery of, a lifestyle medicine program for patients with chronic musculoskeletal pain and metabolic comorbidities. It was hypothesized that patients with more social disadvantage engage with proportionately greater group (vs. individual) and telehealth (vs. in-person) programming.</p><p><strong>Design: </strong>Mixed methods study.</p><p><strong>Setting: </strong>Lifestyle medicine program within a tertiary care academic center.</p><p><strong>Participants: </strong>Adults with chronic musculoskeletal pain and obesity-related metabolic comorbidities who presented to a musculoskeletal-oriented lifestyle medicine program.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>Logistic regression tested whether patients' level of social disadvantage (operationalized as national Area Deprivation Index [ADI] percentile) is associated with their proportion of program engagement via group (compared to individual) and telehealth (compared to in-person) visits. Semistructured interviews among a subgroup of 38 patients explored other program elements that patients perceived to affect equitable and effective program implementation.</p><p><strong>Results: </strong>Among 205 patients (median [interquartile range] age 60 [50-67] years, 169 [82%] female, 145 [71%] White race), worse social disadvantage was associated with an increased proportion of engagement via group (compared to individual) visits (odds ratio [OR], 1.13 per 10-unit increase in national ADI percentile [95% confidence interval (CI), 1.07-1.20], p < .001) and via telehealth (compared to in-person) visits (OR, 1.13 [1.07-1.20], p < .001). Patient-perceived keys for effective participation included the program's holistic, interprofessional, goal-oriented approach and genuine kindness and care by knowledgeable program clinicians. Some patients requested long-term periodic program check-ins to facilitate maintenance of lifestyle changes. Improved insurance coverage, clinic expansion to multiple sites, and after-hours programming would improve access for some patients.</p><p><strong>Conclusions: </strong>Group visits (using shared medical appointments) and telehealth visits improve equitable access to lifestyle medicine interventions.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the sensitivity and specificity of novel motor assessments for traumatic brain injury.","authors":"Paula K Johnson, Ariana M Hedges-Muncy, Erin D Bigler, Lorie Richards, Steven K Charles","doi":"10.1002/pmrj.13411","DOIUrl":"https://doi.org/10.1002/pmrj.13411","url":null,"abstract":"<p><strong>Background: </strong>Portable technology that records movements with high accuracy provides potential for sensitive clinical movement tests for individuals who experienced a traumatic brain injury (TBI).</p><p><strong>Objective: </strong>(1)To present impairments assessed using markerless motion capture (MMC) and (2) to compare the sensitivity and specificity of the MMC-mediated tests to each other and to common clinical tests.</p><p><strong>Design: </strong>Screening study, using as criterion standard the ability to classify participant with TBI versus control participant.</p><p><strong>Setting: </strong>Research laboratory.</p><p><strong>Participants: </strong>The study included 30 individuals with TBI and 101 control participants. Entry criteria included most recent head injury <5 years old, no history of movement issues prior to injury, no movement-affecting medications, and sufficient cognitive ability to follow instructions.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>Performance on MMC-mediated tests and existing clinical analogs. MMC-mediated tests included finger oscillation, simple reaction time, and visually guided movement tasks. For comparison, participants also completed the following clinical tests: Halstead-Reitan finger tapping, simple reaction time test, and Beery Visuomotor Integration test. Impairments were identified as test scores of participants with TBI that fell outside of the 95% interval of control participants' test scores. Random forest analysis was used to calculate the sensitivity and specificity of MMC and clinical tests according to their ability to correctly classify participants with TBI and control participants.</p><p><strong>Results: </strong>MMC-mediated tests revealed impairments in more participants with TBI than clinical tests in all three TBI groups (mild, repeated, and moderate to severe). Similarly, MMC-mediated tests revealed a higher percentage of scores as impairments than clinical tests in all three groups with TBI. Furthermore, MMC-mediated tests proved more sensitive and more specific than clinical tests (70% versus 50% and 98% versus 93%, respectively).</p><p><strong>Conclusion: </strong>MMC-mediated tests are sensitive and specific (compared to traditional clinical tests) and have potential to fill a gap in clinical care of TBI.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial disparities in patients with amputation in an acute care setting in the immediate postoperative period.","authors":"Antonio Mondríguez-González, Rachel Xie, Rachel Esparza, Manasi Sheth, Mark Huang","doi":"10.1002/pmrj.13400","DOIUrl":"https://doi.org/10.1002/pmrj.13400","url":null,"abstract":"<p><strong>Background: </strong>Racial disparities are present in the U.S. medical system and lead to detrimental health outcomes and reduced quality of life for many patients. These can be seen in the increased number of amputations among patients from underrepresented minority groups, in addition to differences in access to appropriate rehabilitation care in many debilitating diagnoses.</p><p><strong>Objective: </strong>To examine racial differences in access to rehabilitation consultation and discharge to an inpatient rehabilitation facility (IRF) among patients in an acute care setting following an amputation.</p><p><strong>Methods: </strong>Retrospective convenience sample at a tertiary care hospital from a limited database. The study included 640 participants ≥18 years of age who had undergone an amputation at an academic hospital between January 2020 and March 2023. Patients <18, pregnant women, prisoners, those who identified as Native Hawaiian due their low number (n = 1), or those who had undergone solely phalangeal amputations were excluded. The primary outcomes of this study were the discharge destination after acute care hospital and acute care length of stay.</p><p><strong>Results: </strong>There was a statistically significant association between age and discharge disposition, with a 2% increase in the likelihood of discharge to IRF for each additional year. The length of stay between different racial and ethnic groups showed statistically significant differences, with Asian patients having the longest (23.3 days) and those identifying as \"two or more races\" having the shortest (11.9 days) stays. When comparing between White, Black, and Hispanic patients, Black patients had the longest length of stay (19.9 days). Lastly, patients who received physiatry consultation were 20 times more likely to be discharged to IRF.</p><p><strong>Conclusion: </strong>Patients from underrepresented minority groups had a longer acute care length of stay. Race and ethnicity did not appear to affect the amputation level or discharge disposition, including discharge to acute inpatient rehabilitation. Age and the presence of physiatric consultation had the greatest impact on determining the discharge disposition of patients with amputations.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in musculoskeletal ultrasound-Chronicle of a 25-year live witness.","authors":"Levent Özçakar","doi":"10.1002/pmrj.13341","DOIUrl":"10.1002/pmrj.13341","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"716-717"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the impact of Keep Your Move in the Tube (KYMITT) on patient AM-PAC scores and discharge disposition.","authors":"Miriah Mattox, Julie Ennis, Matthew McClain, Jennifer Trinidad, Alexander Bajorek, Tamela Fonseca, Katie West, Tonya King, Rebecca Lazensky","doi":"10.1002/pmrj.13315","DOIUrl":"10.1002/pmrj.13315","url":null,"abstract":"<p><strong>Background: </strong>The Sarasota Memorial Health Care System (SMHCS) Acute Care Rehabilitation Team began implementing the Keep Your Move in the Tube (KYMITT) protocol in February 2023 to improve patient mobility and offer an alternative to traditional sternal precautions. The goal of KYMITT is for patients to remain within a safe zone (referred to as \"the tube\") rather than complying with time and weight restrictions, which are the cornerstone of traditional sternal precautions. In previous studies, KYMITT was associated with greater independence after surgery without placing patients at an increased risk of experiencing a surgical site infection.</p><p><strong>Objective: </strong>To test the hypothesis that KYMITT is associated with greater patient mobility and independence, without increasing the risk of surgical complications.</p><p><strong>Methods: </strong>Researchers at SMHCS analyzed records of 614 open-heart surgery patients (n = 293 in the traditional sternal precautions group and n = 321 in the KYMITT protocol group) to determine the differences in their Activity Measure for Post-Acute Care (AM-PAC) mobility scores.</p><p><strong>Results: </strong>The average last-recorded AM-PAC score for the traditional sternal precautions group was significantly lower than for those receiving the KYMITT protocol (19.2 [95% CI: 18.86-19.62] vs. 20.0 [95% CI: 19.62-20.35], p = .006). For patients with at least two AM-PAC scores recorded, the difference was calculated for each patient's first to last AM-PAC score (AM-PAC delta). There was not a statistically significant difference between groups with an average improvement of 2.7 (95% CI: 2.30-3.09) for the traditional sternal precautions group compared to 3.1 (95% CI: 2.71-3.45) for the KYMITT protocol, p = .16 when comparing average AM-PAC delta.</p><p><strong>Conclusion: </strong>Overall, during the 7 months that KYMITT was conducted hospital-wide, a significant increase in average last-recorded AM-PAC scores was observed month to month (slope = 0.45, 95% CI: 0.27-0.62, p < .001).</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"604-611"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spanish Translated Abstracts.","authors":"","doi":"10.1002/pmrj.13443","DOIUrl":"https://doi.org/10.1002/pmrj.13443","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":"17 6","pages":"736-745"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of functional measures to injury severity in runners with Achilles tendinopathy.","authors":"Linh Pham, Logan W Gaudette, Margaret M Funk, Katie E L Vogel, Michelle M Bruneau, Karin Grävare Silbernagel, Joshua Tam, Adam S Tenforde","doi":"10.1002/pmrj.13314","DOIUrl":"10.1002/pmrj.13314","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"726-729"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of peripheral nerve stimulation in refractory postamputation pain: A narrative review.","authors":"Peter D Vu, Diana Ekechukwu, Ovie Enaohwo, Catherine Nguyen, Dominic Vu, Michael V Nguyen","doi":"10.1002/pmrj.13309","DOIUrl":"10.1002/pmrj.13309","url":null,"abstract":"<p><p>The management of postamputation pain remains a significant clinical challenge, with existing therapeutic approaches often yielding inconsistent outcomes. Neuromodulation techniques, particularly peripheral nerve stimulation (PNS), have emerged as promising interventions. However, the evidence supporting their effectiveness in treating phantom limb pain (PLP) and residual limb pain (RLP) remains limited. This narrative review consolidates previous findings of PNS as a postamputation agent and amasses the most recent data on its effectiveness in clinical settings. A literature review was conducted using MEDLINE via PubMed, EMBASE, and Cochrane Library, yielding 115 references. After removing duplicates and applying inclusion criteria, three studies were included. The studies reviewed demonstrate that PNS can offer varying degrees of sustained pain relief, mood enhancement, reduction in opioid use, and functional improvement. However, discrepancies in study design, patient demographics, devices used, and methodological approaches significantly limit the generalizability and reliability of these findings. Currently, the evidence supporting PNS for the treatment of RLP and PLP is limited, with minimal data affirming its efficacy in alleviating postamputation pain and related symptoms. More studies, especially larger, well-designed comparative and observational studies are needed to extrapolate these conclusions for PNS and postamputation pain.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"718-725"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics, proficiency profile, and specialty perceptions of Peruvian physiatrists: A survey study.","authors":"Roger De la Cerna-Luna, Daniel Fernandez-Guzman, Nives Santayana-Calisaya, Analia Velez de Villa-Velarde, Fernando Ylaquita-Chicata, Nataly Casas-Flores, Carol Valladolid-Evaristo","doi":"10.1002/pmrj.13331","DOIUrl":"10.1002/pmrj.13331","url":null,"abstract":"<p><strong>Background: </strong>Despite the growth of physical medicine and rehabilitation (PM&R) in recent years, the same cannot be said for its workforce conditions. Although various issues regarding the reality of the physiatry workforce have been reported, no studies were found that have evaluated it in Peru.</p><p><strong>Objective: </strong>To assess characteristics, proficiency profile, and specialty perceptions of Peruvian physiatrists.</p><p><strong>Design: </strong>Cross-sectional survey, designed and validated by the Peruvian Society of PM&R.</p><p><strong>Setting: </strong>Online anonymous and voluntary questionnaire.</p><p><strong>Participants: </strong>One hundred five Peruvian physiatrists.</p><p><strong>Interventions: </strong>During August 2023, after approval from the ethics committee, a Google Forms questionnaire was shared with the participants via WhatsApp, providing information about study details. Responses were monitored through direct communication with each participant.</p><p><strong>Main outcome measures: </strong>Twenty-four questions covering sociodemographic data, training-related characteristics, work-related characteristics, proficiency perceptions, and specialty perceptions.</p><p><strong>Results: </strong>Most surveyed physiatrists were females (80%) and completed residency between 2017 and 2022 (46.7%). Only 2.8% had pursued a subspecialty fellowship; 41.9% were involved in teaching and easily found employment after residency. Most worked in the public sector (82.9%) and had a permanent employment status under the 728 regime (33.3%). Most reported having much proficiency (Level 3) in all competency domains. Mastery in ultrasound (US) (10.2%) and electrodiagnostic medicine (EDX) (4.1%) was reported mainly by those completing residency between 2017 and 2022. Only 2.9% reported ability to conduct scientific research. Overall satisfaction with the specialty was high (75.2%).</p><p><strong>Conclusions: </strong>The survey found that most of surveyed Peruvian physiatrists worked in the public sector, had permanent employment status, considered themselves highly proficient in all evaluated domains, reported low mastery in US and EDX, and were very satisfied with the specialty. Given the lack of literature, these findings provide valuable insights for policymakers and educators, highlighting key areas for improving conditions for the physiatry workforce.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"673-683"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}